A retrospective study to identify the prevalence of severe maternal morbidity or “near misses” in obstetric patients who are admitted to maternity high care and the Intensive Care Unit at King Edward VIII Hospital.

Abstract

SUMMARY INTRODUCTION Maternal mortality (MM) is still high in low- and middle-income countries; severe lifethreatening maternal morbidity, that also called maternal near miss (MNM) leads to MM and is a maker for quality of obstetric care. MNM occurs where a life-threatening condition has occurred in a woman who is currently pregnant or within 42 days since the end of it. The purpose of our study was to establish the prevalence of maternal near misses (MNM), near-miss ratio (NMR) and to determine underlying causes of MNMs. AIMS AND OBJECTIVES The overall aim of the study was to describe the near misses in obstetric patients and study the associated factors associated with near misses. METHODS A retrospective observational study conducted between 01 April 2015 and 31 March 2016 at King Edward VIII regional hospital in Durban, South Africa. Clinical records of 142 obstetric patients admitted to the intensive care unit (ICU) and maternity high care (MHC) wards were reviewed using the WHO organ dysfunction criteria to identify the maternal near-miss (MNM) cases and underlying causes. RESULTS A total of 54 maternal near miss (MNM) were identified; 6253 live births and 16 maternal deaths occurred. The MNM:MM ratio was 3.4:1, MMR 256/100 000 live births, and the NMR 8.6 per 1 000 live births. Obstetric haemorrhage was the prime cause of MNM; there were 29 (53.7%) cases of obstetric haemorrhage either as a sole complication or in association with hypertension; followed by hypertensive disorders, pregnancy related infection, medical disorders and other obstetric causes in 16.7%, 13.0%, 13.0% and 1.9% patients respectively. Post-partum haemorrhage (PPH) was the leading cause of obstetric haemorrhage in 20 women (69.0%) accompanied by a caesarean section rate of 86.2% among those with severe obstetric haemorrhage. CONCLUSION Avoidable morbidity from obstetric haemorrhage remains high and poses a great threat to maternal survival; reduction of unnecessary caesarean section delivery and intensified efforts to improve the standard of management during delivery, are required to remedy this. Regular facility audits and continuous surveillance of near misses is feasible and is able to identify key causes of morbidity. Reducing MNM is critical to the reduction of maternal mortality.